Patient Blood Management Guidelines: Module 6 Neonatal and Paediatrics ANAEMIA a Hb below reference range for age, sex and gestation Ferritin <20 mcg/L Iron deficiency anaemia Ferritin 20–50 mcg/L Possible iron deficiency anaemia Ferritin >50 mcg/L Unlikely iron deficiency anaemia Review clinical history and identify cause (see Table G.1 in Appendix G of Module 6) Start treatment: oral iron 3–6 mg/kg/day Address causes of dietary iron deficiency: increase dietary iron if <1 year of age, cease cow’s milk and use an infant formula if 1–2 years of age, reduce cow’s milk to <500 mL daily Assess haematological after Hb recovery If oral iron is ineffective or isresponse within 2–4 weeks Continue treatment for 3 months not tolerated, consider other causes of anaemia (see Column 3 of this template) and use of IV iron Review and address any causes of iron deficiency (see Column 1 of this template and Table H.1 in this document) Correlate with MCV/MCH and CRP Consider therapeutic trial of iron oral iron 3 mg/kg/day Assess haematological response within 2–4 weeks If anaemia persists, consider other causes (see Column 3 of this template) Correlate with MCH/MCV and CRP Ferritin may be elevated in the setting of inflammation. However, iron deficiency may still be present, particularly where TSAT <20%. Consider alternative causes of anaemia: thalassaemia haemoglobinopathy anaemia of chronic disease haemolytic anaemia B12 deficiency folate deficiency a This algorithm applies to all patients, including those undergoing procedures in which substantial blood loss is anticipated. b The reference ranges are based on criteria from the Royal College of Pathologists of Australasia, 364 and they may require local adaptation. CRP, C reactive protein; Hb, haemoglobin; IV, intravascular; MCH, mean corpuscular haemoglobin; MCV, mean corpuscular volume; TSAT, transferrin saturation

Patient Blood Management Guidelines: Module 6 Neonatal and Paediatrics Table H.1 Age-specific differential diagnoses in children with iron deficiency INFANTSCHILDRENADOLESCENT Inadequate dietary iron Late introduction of iron-rich solids Early introduction (i.e. <12 months) of cow’s milk Vegetarian or vegan diet Inadequate dietary iron Vegetarian or vegan diet Inadequate dietary iron Vegetarian or vegan diet Increased iron requirements Catch-up growth if premature or low birth weight a Rapid growth period Increased iron requirements Rapid growth period Increased iron requirements Rapid growth period Pregnancy Extreme athletes Intestinal blood loss Cow’s milk protein intolerance Meckel’s diverticulum Inflammatory bowel disease Parasitic infection Other chronic blood loss such as epistaxis, or renal or pulmonary blood loss Intestinal blood loss Meckel’s diverticulum Inflammatory bowel disease Parasitic infection b Other chronic blood loss such as epistaxis, or renal or pulmonary blood loss Intestinal blood loss Inflammatory bowel disease Parasitic infection Menorrhagia Other chronic blood loss such as epistaxis, or renal or pulmonary blood loss Reduced absorption Coeliac disease Inflammatory bowel disease Gastric or intestinal surgeries Helicobacter pylori infection Reduced absorption Coeliac disease Inflammatory bowel disease Gastric or intestinal surgeries Helicobacter pylori infection Reduced absorption Coeliac disease Inflammatory bowel disease Gastric or intestinal surgeries Helicobacter pylori infection Dietary factor (tannins) a Antenatal risk factors that predispose an infant to iron deficiency include maternal iron deficiency, maternal diabetes mellitus, smoking and multiple pregnancies. Perinatal factors that predispose an infant to iron deficiency include low birth weight, prematurity, feto-maternal haemorrhage, twin-to-twin transfusion or other blood loss including placental abruption, subgaleal haemorrhage or iatrogenic blood loss. b Giardia and hookworm infection